Prescribers can consider galcanezumab as an option to prevent migraine in adults who have at least 4 days with migraine each month and in whom at least 3 previous preventive treatments have failed.
Unlike fremanezumab (Ajovy), NICE has ruled that galcanezumab can be used within the NHS to prevent both chronic and episodic migraine.
For migraine that has not responded to at least 3 preventive treatments, NICE concluded from the clinical trial evidence that galcanezumab works better than best supportive care in both episodic and chronic migraine. It may also work better than botulinum toxin type A.
Galcanezumab should be stopped after 12 weeks of treatment if episodic migraine does not reduce in frequency by at least 50% or chronic migraine does not reduce by at least 30%.
The decision by NICE assumes the manufacturer of galcanezumab continues to provide the antibody according to the commercial arrangement.
Like other CGRP inhibitors, galcanezumab targets the process by which proteins cause blood vessels in the brain to swell. It is administered monthly by subcutaneous self-injection.
A third CGRP inhibitor, erenumab (Aimovig), was rejected by NICE last year.